Exam Name: Health Plan Finance and Risk Management
Certification Provider: AHIP
Corresponding Certification: AHIP Certification
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AHIP AHM-520 Exam Overview:
| Certification Vendor: | AHIP |
|---|---|
| Exam Name: | Health Plan Finance and Risk Management |
| Exam Number: | AHM-520 |
| Exam Format: | Scenario-based Questions, Online Assessment, Multiple Choice |
| Available Languages: | English |
| Related Certifications: | Managed Healthcare Professional (MHP) Designation AHM250 - Health Care Management: An Introduction AHM510 - Governance, Legal Issues, Medicare & Medicaid |
| Sample Questions: | DOWNLOAD DEMO |
| Exam Way: | Online course with online assessment/examination delivered through the AHIP Insurance Education platform. |
| Pre Condition: | No formal prerequisite exam is generally required. The course is part of the AHIP Managed Healthcare Professional curriculum and is typically taken alongside other AHM courses toward the designation. |
| Official Syllabus URL: | https://www.ahip.org/courses/health-plan-finance-and-risk-management-ahm520 |
AHIP AHM-520 Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Topic 1: Risk Assessment and Risk Management | - Risk mitigation strategies
|
| Topic 2: Regulatory and Compliance Framework | - Governance and reporting
|
| Topic 3: Provider Payment Models | - Traditional and alternative reimbursement
|
| Topic 4: Claims Analysis and Utilization Management | - Claims data analysis
|
| Topic 5: Medical Loss Ratio and Compliance | - Compliance requirements
|
| Topic 6: Actuarial Principles and Forecasting | - Forecasting methods
|
| Topic 7: Health Plan Financial Structures | - Financial reporting
|
Common Questions About the AHIP Health Plan Finance and Risk Management Exam
The AHIP Health Plan Finance and Risk Management (exam code AHM-520) is the exam you pass to earn the AHIP Certification certification, a credential at the Professional level. It is also connected with related credentials such as AHM250 - Health Care Management: An Introduction, AHM510 - Governance, Legal Issues, Medicare & Medicaid, Managed Healthcare Professional (MHP) Designation. If you are mapping out a certification path with AHIP, this exam is a milestone worth planning around.
No formal prerequisite exam is generally required. The course is part of the AHIP Managed Healthcare Professional curriculum and is typically taken alongside other AHM courses toward the designation.
Eligibility rules can be adjusted by AHIP over time, so before you register, confirm the current requirements on the official exam page: view the official AHM-520 exam information.
Yes. 2Pass4sure offers a free PDF demo of the AHM-520 practice questions, so you can judge the quality of the material firsthand before paying anything. Every purchase also includes 365 days of free updates — if AHIP changes the exam during that year, your material changes with it. And when the free update period expires, you can extend it at a 50% discount from within your member zone.
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The official AHIP Health Plan Finance and Risk Management outline divides the exam content into 7 main domains. The first three are:
- Actuarial Principles and Forecasting
- Medical Loss Ratio and Compliance
- Risk Assessment and Risk Management
That is only the headline view — scroll back up to the Exam Topics section on this page for the complete domain-by-domain breakdown before you plan your study schedule.
AHIP Health Plan Finance and Risk Management Sample Questions:
One way that the Medicare and Medicaid programs differ is that under Medicare, a smaller proportion of provider reimbursement goes to the primary care providers and a greater proportion of the reimbursement goes to hospitals and specialists.
- A. False
- B. True
Ways in which a company can increase its return on investment (ROI) include: 1.Reducing expenses to increase operating income 2.Increasing controllable investment
- A. Both 1 and 2
- B. Neither 1 nor 2
- C. 1 only
- D. 2 only
In a comparison of small employer-employee groups to large employer-employee groups, it is correct to say that small employer-employee groups tend to:
- A. More closely follow actuarial predictions with respect to morbidity rates
- B. Have less frequent and smaller claims fluctuations
- C. Generate more administrative expenses as a percentage of the total premium amount the group pays
- D. Expose an health plan to a lower risk of anti selection
One true statement about a type of capitation known as a percent-of-premium arrangement is that this arrangement
- A. Transfers some of the risk associated with underwriting and rating from a health plan to a provider
- B. Is less attractive to providers when the arrangement sets provisions to limit risk
- C. Is the most common type of capitation
- D. Sets provider reimbursement at a specific dollar amount per plan member
All publicly traded health plans in the United States are required to prepare financial statements for use by their external users in accordance with generally accepted accounting principles (GAAP). In addition, health insurers and health plans that fall under the jurisdiction of state insurance departments are required by law to prepare certain financial statements in accordance with statutory accounting practices (SAP). In a comparison of GAAP to SAP, it is correct to say that:
- A. GAAP is established and promoted by the National Association of Insurance Commissioners (NAIC), whereas SAP is established and promoted by the Financial Accounting Standards Board (FASB)
- B. GAAP provides for a single method of valuing all of a health plan's assets, whereas SAP offers the health plan more than one method for valuing its assets
- C. The going-concern concept is an underlying premise of GAAP, whereas SAP tends to focus on the liquidation value of the MCO or the insurer
- D. The principle of conservatism is fundamental to GAAP, whereas SAP generally is not conservative in nature
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